Impact of SGLT2 inhibitors on urinary tract infections in patients with diabetes mellitus and ileal urinary diversion: a retrospective cohort study

Abstract Purpose The impact of sodium–glucose linked transporter-2 inhibitors (SGLT2i) on urinary tract infection (UTI) risk remains uncertain and may be dose-dependent. No prior studies have evaluated their effect in patients with urinary diversion after cystectomy. This study evaluated the association between SGLT2i use and UTI in patients with diabetes mellitus (DM) after cystectomy and ileal urinary diversion. Methods We conducted a retrospective single-center cohort study including all patients with DM who underwent cystectomy with ileal urinary diversion between March 1996 and November 2023. Primary outcome was UTI occurrence, assessed by incidence rate and infection-free survival (IFS). Secondary outcomes included asymptomatic bacteriuria and glucosuria. UTI incidence rate was compared using Poisson regression. IFS was evaluated using Kaplan–Meier curves, log-rank test and Cox regression analysis. Results Among 123 included patients with DM and ileal urinary diversion, 18 (14.6%) received SGLT2i therapy. Median follow-up was 35 months (IQR 12–83). Overall, 121 UTI were documented, 6 (5.0%) in patients with and 115 (95.0%) without SGLT2i treatment, corresponding to incidence rates of 0.206 vs. 0.210 UTI/patient/year ( p  = 0.959). Median IFS was 9 months (IQR 3–31) in the SGLT2i and 17 months (IQR 5–74) in the non-SGLT2i group, with no significant difference ( p  = 0.489). Conclusion In this cohort, SGLT2i therapy was not associated with an increased risk of UTI in patients with DM and ileal urinary diversion after cystectomy. These findings suggest no evident signal for increased infection risk; however, prospective studies are warranted to confirm these observations.